closed reduction then ORIF

edited May 2017 in Orthopedics
Patient came into the office has a bimalleolar ankle fracture with pressure
on the skin from the distal tiba. He did a closed reduction in the office
and then sent the patient over to the hospital and did surgery on her later
that day. This is a Medicare patient. Is it appropriate to charge for the
closed reduction in the office then the ORIF for later that day or only bill
for the ORIF?

Thanks for any and all opinions!!

Lisa Blodgett, CPC
Liberty Orthopedics


  • edited May 2017
    My thought is, if the surgeon knew the patient was going to have to go to
    surgery before the closed reduction was done, it's probably not billable.
    If the surgeon did the closed reduction and it wasn't successful, then made
    the decision to go the surgery bill for both and use the 58 modifier for
    the ORIF.

    Sandi Hamrick, CPC

    Toledo Orthopaedic Surgeons
  • edited May 2017
    ​In my opinion, if the ORIF was planned, I would just bill the I
    would have billed an extensive E/M since he did the closed reduction, and I
    would have billed for the casting material also....and make sure you send
    the notes as to why...


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